Higher Recoveries

Revenue leakage for healthcare providers is a pervasive problem, costing healthcare providers $125 billion annually in unpaid or underpaid claims. McKinsey & Co estimates that inefficiencies and leakages in the revenue cycle – in claims processing, payments, billing and bad debt – cost the healthcare industry approximately 15 cents on every dollar spent on healthcare. 

“Since our seamless transition, we have significantly increased our monthly collections, decreased the delay in processing claims, and less time is spent in accounts receivable.” 

– Sahil Lalwani, VP of Operations Global7 Diagnostics  

Submission Accuracy

As health codes and billing regulations change regularly, healthcare providers struggle to accurately charge payors and to complete compliance filings. LumaShift’s technology platform helps clients avoid losses and uncover missing charges.  

Internal Classification of Disease (ICD) regulations are getting more complex. The ICD-10 increased the number of medical codes by 8x. The much more complex ICD-11 was released in January 2022. The industry is transitioning to software-based systems to navigate coding and billing. 

Number of Codes for ICD 9/10 ('000)

Curbing denial incidence at the front-end of the revenue cycle is far better than managing them on the back-end. 

Denial Management

LumaShift succeeds in overturning 85% of all claim denials. 

In 2016, nine percent of claims worth three trillion dollars submitted by healthcare organizations were initially denied. By 2020, national denier rate had risen to 11.1%. Furthermore, nearly 2/3 of the denials are not reworked, leaving money on the table

Most denials are preventable (2020)

Root Cause Analysis

“At Medcillary, we identify innovative products and services that are changing healthcare for the better. [LumaShift] provides our clients next-generation A/R forensic recovery and revenue cycle management services – combining professional expertise with advanced processes and technology to deliver amazing results.”

– Jon Boski, CEO of Medicillary

Tackling the causes of claim denials is a proven pathway for healthcare organizations to reduce denials and increase the success rate of claims appeals. However, conducting root cause analysis is challenging when various aspects of the revenue cycle are spread across disparate teams and information silos.  

LumaShift sheds light on previously hidden patterns through clear visualization and organization of data.